- Molina Healthcare (Macon, GA)
- …functionality through project inclusion and documentation review to understand proper claims processing for the applicable solution. Validates data received ... support issues related to EDI transaction editing and custom claims processes to determine root cause of issue. Gains...claims to identify billing issues that will impact claims processing and payment. Monitor new solutions implemented to… more
- Molina Healthcare (Macon, GA)
- …Maintains critical provider information on all claims and provider databases. Synchronizes data among multiple claims systems and application of business ... rules as they apply to each database. Validate data to be housed on provider databases and ensure...and best practices while suggesting improvement processes to ensure systems are working more efficiently and improve quality. +… more
- Elevance Health (Atlanta, GA)
- …** is responsible for providing support, configuration, design, testing and implementation for claims systems . Ensures accurate adjudication of claims , by ... **Pre-Pay Editing Analyst Sr ** **Location:** This role requires associates to be...and the vendor to ensure quality and timeliness of systems /project deliverables. + Configures new designs/updates in the system.… more
- Medtronic (Atlanta, GA)
- …for these individuals. We are hiring a passionate, fast-paced, and strategic ** Sr . Group Market Development Manager** to manage the healthcare professional (HCP) ... and provides strategic support to reimbursement, clinical, and sales teams. The Sr . Group Market Development Manager will focus on increasing healthcare professional… more
- Molina Healthcare (GA)
- …more affordably. Performs research, financial modeling, and analysis of complex healthcare claims data (medical, pharmacy and ancillary) to deliver practical, ... **Job Description** **Job Summary** Sr . Analyst, Network Strategy, Pricing & Analytics guides...(including trend analysis) by utilizing NetworX Modeler and ETL systems to support negotiating strategies, modeling current and future… more
- Molina Healthcare (GA)
- … systems to support executive decision-making + Mine and manage information from large data sources + Analyze claims and other data sources to identify ... **JOB DESCRIPTION** **Job Summary** The Senior Analyst, Medical Economics provides support and consultation...reports, and improvement opportunities based on analyses + Provide data driven analytics to Clinical COE, Finance, Claims… more
- Evolent (Atlanta, GA)
- …manner that fosters expertise and cooperation.** **Process and validate raw unadjudicated claims data .** **Use programming skills to explore, examine and ... **Familiarity with value-based care and utilization management- Preferred.** **Understanding of data systems and the critical thinking skills to solve… more
- Evolent (Atlanta, GA)
- …care/service + Familiarity with value-based care and utilization management + Understanding of data systems and the critical thinking skills to solve new ... activities as well as Product Development efforts. **What You'll Be Doing:** + Analyse claims and authorization data to identify trends, calculate cost of care,… more
- Molina Healthcare (Macon, GA)
- … claims databases. Maintains critical information on claims databases. Synchronizes data among operational and claims systems and application of ... business rules as they apply to each database. Validate data to be housed on databases and ensure adherence...information into the claim payment system and other applicable systems . + Participates in defect resolution for assigned component… more
- Emory Healthcare/Emory University (Atlanta, GA)
- …leadership programs * And more **Work Location:** Atlanta, GA **Description** A Senior Manager of Hospital Billing oversees the entire hospital billing operation, ... ensuring accurate and timely submission of patient claims , managing a team of billing specialists, resolving complex billing issues, maintaining compliance with… more
- Molina Healthcare (GA)
- **JOB DESCRIPTION** **Job Summary** Performs research and analysis of complex healthcare claims data , pharmacy data , and lab data regarding network ... + Healthcare Analyst I or Financial/Accounting Analyst I experience desired + Multiple data systems and models + BI tools To all current Molina employees: If you… more
- Chick-fil-A (Atlanta, GA)
- …lead's knowledge and fend off inflationary asks that are not supported by market data + Develop a bank of knowledge, strategies, and training to arm sourcing leads ... with skills to counter supplier's claims and identify the middle ground + Help sourcing...building, and interpersonal skills + Proficiency in risk management systems including reporting and execution + Knowledge of supply… more
- MetLife (Atlanta, GA)
- …and possess in-depth knowledge of plan designs, benefit features and how claims are paid * Strong understanding of industry marketplace and legal developments. ... all levels of the organization * Ability to analyze data to influence and execute on renewal decisions *...computer navigation skills and ability to work in multiple systems simultaneously (Microsoft suite, different company platforms) * Strong… more
- Highmark Health (Atlanta, GA)
- …evaluates, and processes various Stop Loss (Excess Risk and Reinsurance) claims in accordance with established turnaround and quality standards. Responsible for ... disseminates necessary information to the management. Follows up on pended claims in accordance with department standards. HNAS (Health Now Administrative Services)… more
- Axis (Alpharetta, GA)
- …+ Background in designing, developing, and implementing IT systems within claims operations. + Solid understanding of data analysis, budgeting, and business ... Claims Value Stream Lead will collaborate closely with Claims senior leadership to translate their needs...learn and share knowledge. + **Making Disciplined Decisions:** Use data and analytics to form plans and actions, exercising… more
- Axis (Alpharetta, GA)
- …specialty insurers + A good working knowledge of the workstreams, workflows, processes, and claims systems , in aP&C claims organization, for both North ... multiple departments. The Product Owner would focus on managing and enhancing claims -related products, systems , and processes. Their role involves translating… more
- Intermountain Health (Atlanta, GA)
- …in support of Intermountain Health's key strategy of Expanding Proactive Care. As a Data Analyst-Technical- Senior , you will act in a more senior capacity, ... to strategic initiatives, clinical standards, and operational goals through data insights. Reporting to senior leaders in...or economics and four years of relevant experience performing data analysis. + SQL + Insurance claims … more
- Turner & Townsend (Atlanta, GA)
- … data center design and construction processes, including MEP systems , and structural elements. + Excellent communication, negotiation, and interpersonal skills. ... **Job Description** **Turner & Townsend is** seeking an experienced ** Senior Cost Manager / Quantity** to join our team,...join our team, leading cost management for a high-profile data center campus project for a major technology client.… more
- Otsuka America Pharmaceutical Inc. (Atlanta, GA)
- **Position Summary** The Senior Manager of Field Technology will lead the design, optimization, and delivery of field sales reporting platforms and tools. This role ... in ensuring that our field teams have seamless access to accurate, actionable data to drive performance. The role focuses on managing field-facing technology … more
- Elevance Health (Atlanta, GA)
- … data mining, entity review, law enforcement referral, and use of proprietary data and claim systems for review of facility, professional and pharmacy ... **Investigator Senior ** **Supports the Payment Integrity line of business**...to recover corporate and client funds paid on fraudulent claims . Health insurance experience required with understanding of health… more